How Do You Fill In the Care Health Insurance Claim Form?

1. What is in the 11 pages

Page 1 is a set of "Broad Guidelines". It asks for the form completely filled, signed and submitted in original, and warns that processing will be delayed without original documents ^[1]. It also wants two mobile numbers and an email address ^[1]. It gives the postal address for claim documents: Care Health Insurance, Claims Department, Vipul Tech Square, Tower C, 3rd Floor, Golf Course Road, Sector-43, Gurugram 122009 ^[1]. It also explains the key documents in a sentence each and sets out terms for payment by NEFT.

Pages 2 to 4 are Part A, yours. Pages 5 and 6 explain each Part A field and the format it wants. Pages 7 and 8 are Part B, the hospital's, with guidance on pages 9 and 10. Page 11 is a one-page consent letter ^[1]. One oddity: the printed footer calls both page 7 and page 8 "Page 7", so if Care's helpline refers you to "page 8", it may mean the ninth sheet.

2. Part A, section by section

Part A has eight sections ^[1]. Use block letters throughout, and write the claim intimation number at the top if you already have one.

• Section A, primary insured. Policy number, certificate number (for group cover), the TPA ID if one is printed on your card, the policyholder's name (surname first), address, phone and email.
• Section B, insurance history. Whether you have any other health policy now, the date your first policy started without a break, the other insurer, policy number and sum insured, and whether you were hospitalised in the last 4 years since inception, with date and diagnosis ^[1]. Answer this one carefully. It is the section that ties back to what you disclosed when you bought the policy.
• Section C, the patient. Name, gender, age, date of birth, relationship to the primary insured, occupation, and address if different.
• Section D, the hospitalisation. Hospital name, the room category you actually occupied (day care, single, twin sharing, three or more beds), whether it was injury, illness or maternity, the date the disease was first detected, admission and discharge dates and times, cause of injury, and whether it was medico-legal and reported to the police.
• Section E, the claim. Amounts in rupees with no paise, split into pre-hospitalisation, hospitalisation, post-hospitalisation, health check-up, ambulance and other, then any lump-sum benefits such as hospital daily cash or a critical illness benefit ^[1]. Part (d) is a 13-item documents checklist ^[1].
• Section F, bills enclosed. One line per bill: number, date, who issued it, what it was for, amount. Main hospital bill first, then the count of pre- and post-hospitalisation bills, then pharmacy bills.
• Section G, bank account. PAN, account number, bank and branch, payee name and IFSC ^[1].
• Section H, declaration. You date, sign and give the place.

Read Section H before you sign it. It says a false or untrue statement forfeits your right to reimbursement, it authorises Care or its TPA to get records from any hospital or doctor who treated the patient, and it declares that you have included every bill and will make no supplementary claim except for pre- and post-hospitalisation expenses ^[1]. That last clause is the one that catches people. A hospital bill that turns up after you have filed is, on the form's own wording, outside what you said you would claim.

3. Part B: what the hospital fills

Part B opens by saying it is "to be filled in by the hospital" ^[1]. Section A identifies the hospital, whether it is in Care's network, and the treating doctor's name, qualification and registration number. Section B covers the patient's IP registration number, admission type (emergency, planned, day care, maternity) and status at discharge. Section C is the medical core: ICD-10 codes for the primary diagnosis, additional diagnoses and co-morbidities, ICD-10-PCS codes for up to three procedures, whether the illness is a complication of a pre-existing disease, and whether pre-authorisation was obtained, with a reason if a network hospital did not get one. Injury cases add whether an alcohol or substance test was done, the FIR number, or why the police were not told.

Section D is the hospital's own 16-item checklist, including the patient's photo ID "verified by hospital" and, where it applies, the original death summary ^[1]. Section E is only for a hospital outside Care's network: its PAN, registration number, number of inpatient beds and whether it has an operation theatre and ICU ^[1]. Section F is the hospital's declaration, signed and sealed by the hospital authority.

The page-11 consent letter is yours to sign, addressed to the hospital's medical superintendent, authorising Care to obtain your records ^[1].

4. What to attach